Pathologist warns about colorectal risks

Local pathologists diagnose cases of colorectal cancer on a weekly basis.

Colorectal cancer is the third leading cause of cancer deaths, said Dr. Vassil Kaimaktchiev, a pathologist at Mid-Columbia Medical Center.

It accounts for nine percent of new cancer cases diagnosed in men and women each year and nine percent of cancer deaths each year.

By far the leading killer is lung cancer, for both sexes. It gets diagnosed half as often as prostate or breast cancer yearly, but it kills more often than either of those cancers because no good screening tool catches it early enough to give patients a decent chance at survival.

But unlike lung cancer, colorectal cancer does have a highly effective screening tool: the colonoscopy.

Because colorectal cancer occurs more as people age, health officials recommend adults start getting colonoscopies at age 50, and continue getting them every 10 years.

“When colorectal cancers are detected at an early, localized stage, the five-year survival is 90 percent,” Kaimaktchiev said. “However, only 39 percent of colorectal cancers are diagnosed at this stage, in part due to the underuse of screening.”

That trend is starting to change, however. “I’m seeing many, many more 50-year-olds than I used to,” said Dr. Jeff Mathisen, a surgeon at Mid-Columbia Medical Center who began practice here 11 years ago.

More primary care providers are recommending them, and insurance — both private and government-funded — now cover the procedure, he said.

When patients come to him, they‘re “about 50-50” on getting the colonoscopy. His job is to convince him, and by the time he’s done, nine out of 10 have agreed to do it.

“Some are resistant to do it, others are not healthy enough to undergo the procedure. Others just opt to take their chances.”

In a colonoscopy, the patient is sedated and a tiny, flexible, magnifying camera is inserted into the rectum and up the lower intestine, or colon. The night before, the patient drinks a laxative to completely empty the colon.

And it is this bowel preparation that puts people off, Mathisen said.

“Aside from it causes some inconvenient diarrhea the night before, it’s a very easy study to have done,” he said. “They don’t have pain, they don’t have nausea.”

Mathisen said it’s a curious aspect of American culture that “we believe that everything ought to be detectable, everything ought to be curable, but we’re not willing to do anything that’s inconvenient for ourselves.”

There is a virtual colonoscopy being studied, which is a 3-D CT scan of the colon. But the part that most people don’t like — the bowel preparation — is still necessary. And it is far less accurate at finding polyps, he said.

Mathisen said the most common question he’s asked by patients is whether he will get a colonoscopy at 50.

“My answer is unequivocally yes. I’ve seen the good, bad and ugly of colon cancer. I’ve lost patients, I’ve lost friends.”

On average, screening colonoscopies done just because the patient has reached screening age find cancer in only one out of 100 cases.

Most of the cancers are found in people who reported symptoms, such as rectal bleeding, bowel habit changes, abdominal pain and unexplained weight loss, Mathisen said.

Kaimaktchiev said polyps found during colonoscopies — which are then given to pathologists to analyse — typically measure just one to three millimeters across. A big one might just be a centimeter, which is less than half an inch.

Smaller polyps are usually benign. But as they grow, “At some point there’s a critical mutation and it goes from benign to malignant,” Kaimaktchiev said.